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Knee Pain Relief Until Surgery?

I suffer greatly from arthritic knee pain. I need a knee replacement, but I am getting over breast cancer, so I cannot have the surgery right now. My doctor is giving me Tylenol 3 and indomethacin for pain. It really isn't working, however. I also get knee injections every two months. Is there anything else I can do to get some relief until I can have my surgery?

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I am sorry that you are going through so much in your life right now, and I offer you my heartfelt wishes for a good and speedy recovery.

It would be helpful to know your diagnosis, the dose of indomethacin (Indocin) you are taking, and what type of injections you are getting every two months. Are they steroids (cortisonelike), or hyaluronic acid? I will assume, and forgive me if I am wrong, that you have knee osteoarthritis. If you had rheumatoid arthritis, I would expect you to complain about pain and swelling in your hands, wrists, ankles, and feet.

Several things may help you be more comfortable until your knee-replacement surgery. Consider the following:

Increasing the dose of indomethacin to a maximum of 50 mg every eight hours, when needed, with stomach protection (by taking a PPI drug like Prilosec, Nexium, or Prevacid, food, and an antacid). The reason is that indomethacin can cause stomach problems, ranging from upper abdominal discomfort to stomach pain, stomach ulcer, and even bleeding (upper gastrointestinal hemorrhage). Very often ulcers from the NSAID drugs cause no symptoms.

Trying nonsteroidal anti-inflammatory drugs (NSAIDs) other than indomethacin. Such medications include naproxen (Aleve), ibuprofen (Advil or Nuprin), sulindac, diclofenac, and others. Increase the dosage to maximum tolerated levels. The same rules about stomach protection apply here.

Taking plain acetaminophen (Tylenol), in 500 to 650 mg doses regularly every eight hours and using the codeine (Tylenol 3) only for severe pain as needed. Because Tylenol taken over the long term can cause liver damage, your physician may want to test your liver enzymes while you are taking it. As far as using codeine or hydrocodone, both are opioid narcotic drugs and can cause constipation. Try to prevent constipation by eating salads and other vegetables, plenty of fruit and foods with fiber (whole-wheat bread and cereal rich in fiber) and drink plenty of water. Taking a fiber product like psyllium, available under various brand names, may help as well.

Using warm or cold compresses, whatever works for you, three times a day. If your knee feels warm and inflamed, cold compresses will feel better. If it is cool, but still painful, try warm compresses. The compresses (or cold or heat pack) should be kept on for ten to 15 minutes.

Exercising your range of motion gently but consistently after using the compresses and doing quad-muscle strengthening three times a day. An easy way to do this is to hold your leg with the knee straight (or as straight as it gets) for a count of five to ten seconds, then bend it as far back as possible, and repeat five times, morning, noon, and evening. A physical therapist can give you a good home-exercise program, if you do not already have one.

Trying to lose some weight (if you are overweight). Do this slowly and steadily -- no fad diets! This will help ease the load on your knee.

Using a knee brace when you walk -- the type should be determined by the orthopedic surgeon who will do your surgery.

Using a cane on your good side, or a walker.

Having hyaluronate injections, if you've never tried them. There are several brands available. This should be done by a rheumatologist or an orthopedic surgeon. You get one injection every week for three weeks. Depending on the patient, these injections may provide knee pain relief for as long as six months.

Having steroid (cortisone-like) injections into the knee, which may be indicated if there is joint inflammation. Such an injection may provide pain and inflammation relief for three to six months. Just be sure to check with your surgeon first. Most orthopedic surgeons do not allow any joint injections in the few months before surgery, for fear of infection.